The spread of Ebola in West Africa centres on a region with a shared recent history of transnational civil war and internationally led post-conflict reconstruction efforts. This legacy of conflict and shortcomings in the reconstruction efforts are key to understanding how the virus has spread. The dynamics of warfare tied into and accentuated the state’s remoteness from many people. Ebola has simply unmasked persisting deep public suspicion and mistrust of the state, laying bare the limits of post-conflict reconstruction to transform state-society relations. The reconstruction emphasis on rehabilitating pre-existing governance structures – such as the paramount chieftancy in Sierra Leone – did not redress deeply rooted social inequalities, with the result that many people have been marginalised. Ebola’s impacts threaten to undo some of the advances made since the wars ended in Sierra Leone and Liberia, yet there are critical lessons to learn about how to better support societies shaped by violence and war.